Provider Demographics
NPI:1740474568
Name:FULCHER, KRISHA CHARLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISHA
Middle Name:CHARLENE
Last Name:FULCHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2804 W MARC KNIGHTON CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-6300
Mailing Address - Country:US
Mailing Address - Phone:352-746-8067
Mailing Address - Fax:352-746-8003
Practice Address - Street 1:2804 W MARC KNIGHTON CT
Practice Address - Street 2:SUITE A
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-6300
Practice Address - Country:US
Practice Address - Phone:352-746-8000
Practice Address - Fax:352-746-8003
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY7548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical